Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

COVID-19 Omicron variant-inhibitory in silico evidence for phytocompounds of an ancient Ayurvedic formulation

The emerging SARS-COV-2 variants and the global COVID-19 outbreak underscore the urgent need for prophylactics and improved antivirals. Scientists are racing to develop vaccines and antiviral drugs. While vaccinations will be the primary pandemic prophylactic and, appropriate antiviral medications will be needed as a treatment strategy. The variant strains of the virus spawned the second and third waves in several countries, and it affected universally. Antiviral drugs with novel mechanisms of action are still needed to combat emerging SARS-CoV-2 mutations. The present research confirmed in silico the prospective efficacy of an ancient Ayurvedic formulation made for prophylactic and treatment material against symptoms similar to the COVID-19 Wuhan_Hu_1st strain, which had been provided with similar in silico evidence in our earlier report. Clinical studies with safe chemical cocktails may have prospects for countries where the practice of Ayurveda is not legal

Drug Repurposing for COVID-19 from FDA Approved and Experiment Stage Drugs by in Silico Methods with SARS CoV-2 Spike Protein

E-pharmacophore based virtual screening of DrugBank database is carried out to identify candidate drugs for repurposing. The dug molecules were screened based on the pharmacophore generated and filtered through the 6000 drug molecule to obtain better 2000 of them. This filtered drug molecules further screened via structure based approach, involving molecular docking at different precisions. From the large database seven drug lead molecules were selected as hits and their binding energy with the spike protein were calculated. Cladribine, Clofarabine, Fludarabine from approved category and 7-methyl-guanosine-5\u27-triphosphate-5\u27-guanosine, Adenosine-2\u27-5\u27-Diphosphate, 8-Bromo-Adenosine-5\u27-Monophosphate, Alpha-Methylene Adenosine Monophosphate in the experimental category were found to be potent inhibitors of SARS CoV-2 spike protein to repurpose as drugs for COVID-19

Drug Repurposing for COVID-19 from FDA Approved and Experiment Stage Drugs by in Silico Methods with SARS CoV-2 Spike Protein

E-pharmacophore based virtual screening of DrugBank database is carried out to identify candidate drugs for repurposing. The dug molecules were screened based on the pharmacophore generated and filtered through the 6000 drug molecule to obtain better 2000 of them. This filtered drug molecules further screened via structure based approach, involving molecular docking at different precisions. From the large database seven drug lead molecules were selected as hits and their binding energy with the spike protein were calculated. Cladribine, Clofarabine, Fludarabine from approved category and 7-methyl-guanosine-5'-triphosphate-5'-guanosine, Adenosine-2'-5'-Diphosphate, 8-Bromo-Adenosine-5'-Monophosphate, Alpha-Methylene Adenosine Monophosphate in the experimental category were found to be potent inhibitors of SARS CoV-2 spike protein to repurpose as drugs for COVID-19.</jats:p